Cutting Edge Treatments for Dysfunctional Nerves
Injury and disease of the nerves, known as “neuropathy”, can be disabling and cause significant distress. Neuropathy can cause symptoms of pain, burning, weakness, heaviness, numbness, restlessness and swelling which are often difficult to control. Many factors can contribute to nerve dysfunction, nerves can be compressed by discs, bones or tight spaces, they can be stretched or cut by trauma or surgery, nerves can have insufficient blood supply or they can be chemically injured by toxins such as alcohol and medications.
Medications and steroid injections often cannot cure the conditions leaving some patients with chronic pain and disability. Luckily, latest research has shown that perineural injections (injections around sick nerves) with dextrose and platelet rich plasma (PRP), along with nerve hydrodissection are safe and effective non-surgical treatments to heal dysfunctional nerves.
Perineural Injection Therapy (PIT) with Dextrose
Dextrose is a type of sugar solution that has been used therapeutically in various ways within the medical field. In high concentrations, it is used to stimulate growth and healing of ligaments and tendons (for prolotherapy injections). But at low concentrations, 5% dextrose diluted in sterile water, it is used to decrease nerve inflammation and improve nerve function.
About 40% of our sensory nerves have a function beyond sensation. These specialized nerves, known as peptidergic nerves, produce hormones (known as neuropeptides) that support tissue health, function and healing properties.
These nerves are found everywhere (just under the skin, around joints and tendons and around other larger nerve trunks). When these peptidergic sensory nerves become irritated and overactive, they can actually produce inflammatory substances (aka cytokines) that can cause chronic pain, inflammation and tissue degeneration. This is known as neurogenic inflammation. It can cause larger nerve trunks to swell up and become constricted, leading to further nerve injury, pain and dysfunction.
Neurogenic inflammation does not adequately respond to arthritis anti-inflammatory medications such as ibuprofen and naproxen, nor does it fully respond to steroids. Over the last 20 years, the work of Dr. Lytgoft and other researchers have shown that injection of 5% dextrose around nerves very quickly turns off neurogenic inflammation.
A series of repeated injections delivered to the proper location along with a hydrodissection technique can actually heal inflamed nerves and provide a long term cure for chronic pain. It is proposed that 5% dextrose turns off cell receptors responsible for neurogenic inflammation, “feeds” the energy starved nerves and alters the threshold for nerve firing (making the nerve less excitable).
Are You a Candidate for Nerve Injections?
Nerve Injections with Platelet Rich Plasma (PRP)
For some of the more severe nerve injuries, Platelet Rich Plasma (aka PRP) may be added during the course of treatment. PRP is made by spinning the patient’s own blood with a centrifuge to concentrate platelets in a plasma solution. Platelets are responsible for stimulating a regenerative response after an injury as they are packed with growth factors that mobilize the immune system to heal.
PRP has been shown to stimulate nerve healing and improve nerve function in multiple human and animal studies. A recent study of patients with diabetic neuropathy showed that PRP injections around their peripheral nerves significantly decreased their pain and numbness.
Several studies have shown that PRP is an effective treatment for carpal tunnel syndrome (a common overuse injury to the median nerve at the wrist) and that it is more effective than other injection treatments. Human and animal studies have shown that PRP injections around injured and severed nerves improved nerve recovery and function.
PRP can be injected around the abnormal nerve at the site of injury, above and below the injury and into the muscle bellies where the nerves connect to the muscle.
PRP Can Initiate Nerve Healing Through the Following:
- Promotes sprouting and growth of nerve fibers (axons)
- Promotes myelin production (protective sheath around nerves)
- Improves growth of blood supply to the nerve
- Decreases scar formation within and around the nerves
- Decreases inflammation of the nerve and surrounding tissue
- Improves Schwann (nerve helper) cell survival, multiplication and activation
- Mobilizes and stimulates fibroblasts and stem cells to heal the nerve
- Increase muscle growth and recovery of muscle function
Nerve Hydrodissection (Nerve Release Injection)
The word hydrodissection comes from two words: “hydro” fluid or water and “dissect” to open up or separate. Nerve Hydrodissection is a nonsurgical technique used to free up inflamed and injured nerves thus allowing them to heal and improve in function. Tissues such as fascia, scars, muscles and tendons can adhere to inflamed nerves making it difficult for the nerves to move and glide properly. This tissue congestion can further contribute to nerve dysfunction and can prevent proper nerve function and healing. Dextrose, PRP or a combination of the two are the preferred solutions used for hydrodissection.
For the procedure, the course of the nerve is mapped using a high resolution ultrasound. Next, under ultrasound guidance, a thin needle is used to carefully inject the solution around the nerve separating it from surrounding scar tissue and fascia. Once the nerve is released, nerve inflammation resolves, symptoms quickly improve and the nerve becomes free to move and heal.
Non-Injection Treatments Used with Regenerative Nerve Injections
To improve the effects of the treatment, injections are often followed by energy medicine modalities, nerve specific physical therapy and nutritional support.
- Laser & LED Therapy can further decrease nerve inflammation, stimulate nerve regeneration and increase muscle growth.
- Pulsed Electromagnetic Field Therapy (PEMF) Low intensity electromagnetic waves pulsed at the earth’s natural frequencies can increase cellular energy, improve blood flow and nutrient utilization and stimulate tissue healing.
- Microcurrent Electrical Stimulation uses small currents to help reset the electrical impulse in the nerve and stimulate nerve growth.
- Nerve Specific Physical Therapy is started early on after the injection, nerve stretching and “nerve flossing” are used to keep the nerve free and moving, neuromuscular re-education of the muscles and joints is used to promote the proper function of the nerves and muscles.
- Diet and Nutritional Support is often added to optimize the healing environment within the body. Nutritional deficiencies may also be addressed by high quality nutritional supplements.
What to Expect with Your Nerve Injection Treatment
Some conditions may improve with 1-3 treatments and some may require 4 or more. Dextrose injections are spaced 1-4 weeks apart while PRP injection may be spaced further (2-6 weeks) to allow adequate time for healing. Between injections, patients are enrolled in specific physical therapy the above mentioned healing modalities and nutritional support.
On the day of your procedure, the medical staff will first collect your blood for processing if PRP is used. Next, Dr. Sebastian will map out the nerve path with an ultrasound and may anesthetize the nerve and injection site with lidocaine. Once everything is ready, Dr. Sebastian will inject the solution along the course of the nerve and into the target muscles under ultrasound guidance. The injection area will be covered by a dressing. After the procedure, there may be some soreness, bruising and swelling which is normal and expected. Often, patients feel significant improvement of their symptoms within 15-20 mins, but sometimes it may take several hours to days.